Tuesday, March 12, 2013

Addiction risk increased after mild traumatic brain injury

A study of military personnel suggests that individuals who have suffered a mild traumatic brain injury (TBI) are at increased [risk] for addiction-related disorders.Casserly Whitehead (Wright-Patterson Air Force Base, Ohio) and team found that mild TBI was associated with an increased risk for alcohol dependence up to 180 days after the event, and an increased risk for nondependent abuse of drugs or alcohol, and nicotine dependence within the first 30 days."Given the increasing emphasis and awareness of mild TBI in both military and civilian populations, these findings may have far-reaching clinical and military readiness implications," comment the authors in the American Journal of Psychiatry.The findings come from a study of 5065 active-duty airmen who had sustained a mild TBI resulting in transient confusion or disorientation, memory loss, and/or brief loss of consciousness, and a comparison group of 44,733 airmen who had sustained other types of injury.After accounting for factors such as gender, marital status, ethnicity, age, deployment status, education level, rank, and career field, the team found that the risk for alcohol dependence was significantly increased in individuals with a mild TBI at 1-30, 31-179, and 180 days post diagnosis compared with those in the comparison group, at hazard ratios (HR) of 3.48, 2.66, and 1.70, respectively.Individuals with a mild TBI also had a greater risk for nicotine dependence (HR=2.03) and nondependent abuse of drugs or alcohol (HR=2.11) in the first 30 days after diagnosis than those in the comparison group.The risks for drug dependence, opioid dependence or abuse, and caffeine-related disorders were also increased in the mild TBI group, but the number of cases in the mild TBI group was too small to produce accurate estimates of risk.Whitehead et al comment: "Any alcohol or drug use after TBI is concerning given the potential for reduction in spontaneous healing, risk of seizure or repeat TBI, and exacerbation of residual cognitive, emotional, and behavioral impairments."They conclude: "Screening for addiction-related disorders should be considered as part of routine care for mild TBI and might best capture the first 30 days post-mild TBI, with repeat alcohol screening thereafter for at least 6 months following the injury."